Retinal Fluorescein, Indocyanine Green Angiography, and Optic Coherence Tomography in Non-Hodgkin Primary Intraocular Lymphoma

Abstract

To determine the presence of clinicopathological correlations for primary intraocular non-Hodgkin lymphoma (NHL)in fluorescein angiographies (FA), indocyanine green (ICGA) angiographies, and optical coherence tomography (OCT) images. Comparative retrospective interventional case series. Institutional practice. All serial patients who underwent vitreous sampling for cytological analysis over a 70-month period were reviewed. Clinical, angiographic, and tomographic findings present prior to tissue diagnosis were re-evaluated in a masked fashion. Cytological analysis of 256 vitreous specimens from 244 patients was performed. The final diagnoses were infections in 42 cases (17.2%) and immune-mediated diseases in 34 cases (13.9%). In 59 cases (24.2%), neoplastic disease was present, and 53 (21.7%) of these were primary intraocular NHL. OCT images showed nodular hyperreflective lesions in the retinal pigment epithelium (RPE) of both intraocular NHL and nonintraocular NHL patients. Clusters of numerous hypofluorescent small lesions revealed by FA that corresponded to punctate whitish lesions in the fundus and rare round clustered hypofluorescent lesions revealed by ICGA were associated with intraocular NHL diagnosis. The positive predictive value was 88.9% and the negative predictive value was 85%. The odds ratio risk was 45.22. The presence of clusters of round stable hypofluorescent lesions in FA that are scarce in ICGA, with corresponding RPE hyperreflective nodular lesions on OCT, warrants obtaining biopsies for cytology, immunostaining, and molecular biology exams.